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::CHMRM0::                       ;chest MR for mediastinum
(
Purpose: History of atypical chest pain, r/o mediastinal mass lesion clinically.
Pulse sequences: EKG-gating coronal and axial T2 TrueFISP, axial T1 HASTE with/without fat suppression for morphology of mediastinum. 
MR findings:
* mild cardiomegaly. Left side aoric arch and descending aorta with normal three cephalic branches. 
* no eveidence of abnormal mass lesion is noted in mediastinum. Please correlate with clinical findings. 
* lung can't be well evaluated in MR study.

IMP:
no eveidence of mediastinal mass.  
)

::CHMRLVOT0::              ;chest MR for LVOT normal Form
(
Purpose: History of subvalvular aortic stenosis causing LVOT obstruction and LV hypertrophy s/p Morrows operation and aortoplasty. For post-op LVOT and LV function.
Pulse sequences: ECG-gating axial and sagittal T1WI dark blood HASTE and T2 TrueFISP cine. 
MR findings: 
* increased diameter of LVOT and supravalvular ascending aorta (about 2.8 cm) as compared with the previous MR (pre-operation) in 2007/09/11. The cross sectional area of the LVOT at end systole measures about 3.0 cm^2.     
* moderate aortic regurgitation and mitral regurgitation. Mild trucuspid regurgitation.
* no definite hypertrophy of the LV wall.
* LV function: To be continued
)

::CHMRDAA::
(
Purpose: aortic dissection, Stanford type B, for follow up.
Pulse sequences: ECG-gating T1W dark blood HASTE, and T2W TrueFISP.
MRI findings:
* aortic dissection from proximal descending aorta down to bil common iliac arteries. Both true lumen and false lumen are patent. There is mild partial thrombus in the false lumen. The maximal diameter of the descending aorta measures about 5.5 cm. As compared with the previous MRI study on 2007-07-04, it was 5.2 cm. Progressive enlargement of the aneurysm is impressed. The diameter of the ascending aorta measures about 4.5 cm. 
* The celiac trunk, SMA, and right renal artery arise from the true lumen. The orifice of the left renal artery seems to arise from the false lumen. Atrophy of the left kidney is noted.
* mild bilateral pleural effusions.
* The maximal diameter of the abdominal aorta measures about 4.3 cm at the level just above the celiac trunk.
IMP:
Aortic dissection, Stanford type B. Progressive enlargement of the aneurysm in the descending aorta.
)

::CHMRCADSVR::                ;CAD s/p CABG and SVR
(
Purpose: CAD, 3VD, ICMP, s/p CABG, AVP, MVP, TVP and SAVER. For LV function.
Pulse sequences: ECG-gating TrueFISP cine for LV function, and post-Gd IR-prepped segmented TurboFLASH for myocardial scarring.
MRI findings:
* relatively reduced sizes of LV and LA. There is no transvalvular regurgitation or stenosis.
* relatively improved contractility of the LV walls at basal and mid LV level. The LV apex is separated from the main LV cavity by a disk. Akinesia of the wall of the LV apex and a small mural thrombus are noted. 
* hyperenhancement (>50% transmurality) at the akinetic segments mentioned above. There is diffuse faint hyperenhancement of the LV myocardium. Diffuse myocardial fibrosis due to ischemic cardiomyopathy is considered.
* LV function and mass: to be continued.
)

::CHMRCAD::                   ;CAD
(
Purpose: CAD s/p CABG and mitral valvular replacement on March 12, 2008. For LV function and myocardial scarring.
Pulse sequences: ECG-gating breath-holding TrueFISP cine for LV function and IR-prepped segmented TurboFLASH for myocardial scarring.
MRI findings:
* dilated LV and LA. Moderate mitral regurgitation, moderate aortic stenosis and mild tricuspid regurgitation are noted.  Mild pericardial effusion.
* Global moderate hypokinesia of the LV wall.  Severe hypokinesia is noted at the basal inferolateral, basal inferior, mid inferolateral and mid inferior segments. 
* transmural hyperenhancement at the basal inferior, basal inferolateral, and mid inferior segments. Dark endocardial lesion is noted at the basal and mid inferior segments, indicating presence of microvascular obstruction. Subendocardial hyperenhancement is noted at the mid inferolateral and basal anteroseptal segments.
* LV function (To be continued)
)


::CHMRHCM::                   ;hypertrophic cardiomyopathy
(
Purpose: R/O hypertrophic cardiomyopathy.
Pulse sequences: ECG-gating TrueFISP cine for LV function, and delayed enhanced IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* normal sizes of cardiac chamber. No definite hypertrophy of the LV wall is noted. There is mild mitral regurgitation.
* normal contractility of the LV/RV walls. There is sluggish early LV dilatation followed by atrial kick. R/O diastolic dysfunction.
* no definite hyperenhancement in the LV/RV walls.
* LV function and mass: to be continued.
)


::CHMRPA::                         ; pulmonary atresia.
(
Purpose: SOB, palpitation, Echo: R/O pulmonary HT, Eisenmenger syndrome.
Pulse sequences: ECG-gating T1W dark blood HASTE, TrueFSIP, contrast-enhanced 3D MRA, TrueFISP cine, and IR-prepped segmented TurboFLASH.
MRI findings:
* normal sizes of the cardiac chambers. Mild hypertrophy of the RV wall is noted. There is no transvalvular stenosis or regurgitation. Minimal pericardial effusion is noted. 
* Straightening of the interventricular septum at early diastole. Elevated RV diastolic pressure is considered. Normal contractility of the LV/RV walls.
* Abscence of right pulmonary artery is noted. Congenital right pulmonary artery aplasia is considered. Prominent bronchial arteries are noted supplying the right lung. Focal infiltrates are found in the periphery of right lower lobe.
* Engorged pulmonary trunk and left pulmonary artery. There are suspicious multiple stenoses at the left pulmonary arteries with post-stenotic dilatation. 
* no definite hyperenhancement in the LV/RV myocardium.
* LV function and mass: to be continued.
)

::CHMREBS::                   ;Ebstein anomaly s/p Brock procedure
(
Purpose: Ebstein anomaly s/p Brock procedure and PVP, TVP, ASD repair and right heart MAZE.
Pulse sequences: ECG-gating phase contrast cine for flow quantification, 3D contrast enhanced MRA for pulmonary arteries imaging, TrueFISP cine for RV function and IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* mildly dilated RV and RA. Moderate pulmonary regurgitation, moderate pulmonary stenosis, and mild tricuspid regurgitation are found.
* corrected positin of the tricuspid valves. 
* normal contractility of the RV wall.
* engorged MPA.
* no definite hyperenhancement in the RV or LV myocardium.
* PR index (To be continued)
)

::CHMRAMI::                   ;for acute myocardial infarction.
(
Purpose: R/O AMI or acute myocarditis.
Pulse sequences: ECG-gating contrast enhanced MRA, TrueFISP cine for LV function, and delayed enhanced IR-prepped segmented TurboFALSH for myocardial scarring.
MRI findings:
* normal sizes of cardiac chambers. Moderate mitral regurgitation and mild aortic regurgitation and stenosis are found. There is mild pericardial effusion and bil pleural effusions.
* global hypokinesia of the LV wall. 
* scattered small patches of hyperenhancement mostly at the outerwall of the septum and anterior wall of the LV. The enhancement pattern is compatible with acute myocarditis. Advise clinical correlation.
* LV function and mass: to be continued.
)

::CHMRICMOP::                    ;ischemic cardiomyopathy s/p SVR
(
Purpose: ICM s/p CABG + MVP + SVR. HYHA2. For LV function and myocardial scarring.
Pulse sequences: ECG-gating TrueFISP cine for LV function and IR-prepped segmented TurboFLASH for myocardial scarring.
MRI findings:
* cardiomegaly with mild pericardial effusion and pleural effusion.
* global hypokinesia of the LV walls. The apical LV is separted by a patch due to SVR, and shows akinesia. There is no leakage of the patch.
* transmural hyperenhancement at the mid anterior, mid anteroseptal, mid inferior, apical anterior, apical septal, apical inferior segments. 
* LV function and mass:to be continued.
)

::CHMRICM::                    ;ischemic cardiomyopathy with congestive heart failure
(
Purpose: ICMP with CHF. For pre-surgical evaluation.
Pulse sequences: ECG-gating breath-holding TrueFISP cine for LV function, and IR-prepped segmented TurboFLASH for myocardial scarring.
MRI findings:
* cardiomegaly with four chamber dilatation. Moderate to severe tricuspid regurgitation, and moderate mitral regurgitation are found. Mild pericardial effusion and bil. pleural effusions.
* severe hypokinesis of the LV and RV walls. 
* diffuse subendocardial hyperenhancement. Near-transmural hyperenhancement is noted at basal inferior and mid inferior segment. The hyperenhancement also involves the postereomedial papillary muscle. 
* LV function (To be continued)
)


::CHMRMARFAN::               ;Marfan syndrome
(
Purpose: Marfan syndrome with chest tightness. For assessment of the aorta.
Pulse sequences: ECG-gating T1WI dark blood HASTE, TrueFISP and 3D contrast-enhanced MRA.
MRI findings:
* normal caliber of the thoracic aorta and abdominal aorta. No definite intimal flap is noted. No evidence of aortic aneurysm or aortic dissection.
* mild bilateral pleural effusions.
* good visualization of the major branches of the aortic arch, celiac trunk, SMA and bilateral renal arteries.
)

::CHMRDCM::                     ;dilated cardiomyopathy
(
Purpose: DCMP s/p HTX for 12 years. For LV function, myocardial perfusion and fibrosis.
Pulse sequences: ECG-gating SR-prepped TurboFLAHS for myocardial perfusion, TrueFISP cine for LV function, and IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* dilated LA and RA. Mild mitral regurgitation and aortic regurgitation are found. Moderate amount of pericardial effusion.
* poor motility of the LA and RA walls. No definite hypokinesis in the LV or RV walls.
* faint and patchy hyperenhancement at the interventricular septum (close to the RV side) and LV lateral wall. Hyperenhancement at the LA and RA walls is also found.
* LV function: to be continued
)

::CHMRVSD::
(
Purpose: VSD s/p repair. For PR fraction and RV function.
Pulse sequences: ECG-gating free breathing contrast enhanced 3D MRA, Turbo FLASH cine for RV function and navigator-echo gated IR-prepped 3D segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* mild dilatation of RV. Moderate to severe pulmonary regurgitation is found.
* normal contractility of the LV/RV walls.
* no definite hypernehancement of the LV/RV myocardium.
* PR fraction (To be continued)
* RV function (To be continued)
)

::CHMRARVD::
(
Purpose: PSVT and family history of ARVD. For follow up.
Pulse sequences: ECG-gating T1W dark blood HASTE with and without fat suppression for cardiac morphology, TrueFISP cine for RV/LV function, and delayed enhanced IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* normal sizes of cardiac chambers. No definite transvalvular stenosis or regurgitation is found.
* no definite hypokinesia or focal bulging in the LV/RV walls.
* no definite hyperenhancement in the LV/RV myocardium.
The above MRI findings do not provide evidence for the diagnosis of ARVD.
* RV function (To be continued)
)

::CHMRTOF::
(
Purpose: TOF s/p total correction. For RV function, pulmonary arteries morphology, and PR fraction.
Pulse sequences: ECG-gating phase contrast cine for flow quantification, contrast enhanced 3D MRA for vascular imaging, TrueFISP cine for RV function and regional wall motion, and delayed enhanced IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* Mild dilatation of the RV and RVOT. There are mild to moderate pulmonary regurgitation and pulmonary stenosis. 
* mild hypokinesia of the RV wall. Straightening of the interventricular septum during diastole. Elevated RV diastolic pressure is considered.
* no definite segmental stenosis in the MPA or bilateral pulmonary arteries.
* focal hyperenhancement at the RVOT and basal septum, probably due to OP change.
* PR fraction (To be continued)
)

::CHMRTOF2::
(
Purpose: TOF s/p total correction. For RV function, PR fraction, pulmonary arteries morphology and RV myocardial fibrosis.
Pulse sequences: ECG-gating phase contrast cine for flow quantification, contrast enhanced 3D MRA for vascular imaging, TrueFISP cine for RV function, and IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* dilated RV. Moderate pulmonary regurgitation and mild pulmonary stenosis are found. 
* normal contractility of the LV/RV walls. Mild straightening of the interventricular septum is noted at early diastole.
* right side aortic arch with abberant left subclavian artery. The first branch is left common carotid artery, the second branch is right innominate artery, and the third branch is ALSA.
* no definite hyperenhancement of the LV/RV myocardiu.
* PR fraction (To be continued)
)

::CHMR::
(
Purpose:
Pulse sequences: ECG-gating T1WI dark blood HASTE (or TurboSE) without/with FS for morphology, phase contrast segmented TurboFLASH cine for flow quantification, contrast enhanced 3D MRA for vascular imaging, TrueFISP (or Segmented TurboFLASH) cine for RV function and regional wall motion, SR-prepped TurboFLASH for myocardial perfusion, and delayed enhanced IR-prepped segmented TurboFLASH for myocardial fibrosis.
MRI findings:
* morphological assessment
* valvular stenosis or regurgitation
* LV/RV wall motion/function
* hyperenhancement/fibrosis
* LV perfusion
* flow quantification, PR fraction, etc. (To be continued)
)


::CHMRCOA::
(
Purpose: R/O coarctation of aorta.
Pulse sequences: ECG-gating T1W dark blood HASTE and T2W TrueFISP.
MRI findings:
* normal caliber of the aorta; ascending aorta measures about 4.1 cm, and descending aorta measures about 2.7 cm.
* no definite aneurysm or coarctation of aorta.
* no evidence of aortic dissection.
* mild fibrotic change at left lower lobe of lung.
)

::CHMRALDO::           ;cardiac MR for aldosteronism study
(
Purpose: aldosteronism & suspected a left adrenal nodule.
Pulse sequences: ECG-gating TrueFISP cine for LV function and regional wall motion, SR-prepped TurboFLASH for myocardial and renal perfusion, IR-prepped segmented TurboFLASH for myocardial fibrosis (pre- and post-contrast), post-contrast T1WI and T2WI for abdominal image.
MRI findings:
* Normal size of the cardiac chambers.
* Normal contractility of LV and RV wall.
* No transvalvular regurgitation or stenosis.
* No definite hyperenhancement of the myocardium.
* A left adrenal nodule, about 1.2 cm at medial limb with high signal intensity on T2 weighted image and peripheral rim enhancement on T1 post-contrast sequence. Adrnal adenoma is considered. There is no definite focal lesion of the visible liver, pancreas, and spleen.

* LV function and mass: to be continued
* Myocardial and renal perfusion: to be continued
)

::CHMRX::              ;cardiac MR for syndrome X
(
Purpose: syndrome X is suspected by clinical doctor
Pulse sequences: ECG-gating TrueFISP cine for LV function and regional wall motion, SR-prepped TurboFLASH for rest and stress myocardial perfusion, IR-prepped segmented TurboFLASH for myocardial fibrosis (pre- and post-contrast)
MRI findings:
* Normal size of the cardiac chambers.
* Normal contractility of LV and RV wall.
* No transvalvular regurgitation or stenosis.
* No definite hyperenhancement of the myocardium.

* LV function and mass: (to be continued)
* Rest and stress myocardial perfusion (to be continued)
)

::CHMRCPC::                ; cardiac MR for constrictive pericarditis.
(
Purpose: CHF, cause undetermined. R/O constrictive pericarditis or AMI.
Pulse sequences: ECG-gating T1WI dark blood HASTE, TrueFISP for cardiac and pericardial morphology, breath-holding TrueFISP cine for LV function, and IR-prepped segmented TurboFLASH for myocardial scarring.
MRI findings:
* thickening of the visceral and parietal pericardium with mild pericardial effusion. There is vivid hyperenhancement of the visceral pericardium surrounding the LV and RV walls, causing hinderance of diastolic expansion. Effusive constrictive pericarditis is considered.
* normal contractility of the LV and RV walls. 
* normal sizes of cardiac chambers. Mild mitral regurgitation is noted. 
* condolidation in left lower lobe with left pleural effusion.
* no definte hyperenhancement in the LV or RV walls. No evidence of previous AMI.
* LV function and mass: to be continued.
)


